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We investigated whether hydrogen peroxide (H2O2)-induced oxidative stress causes human trabecular meshwork (HTM) cell dysfunction observed in open angle glaucoma (OAG) in vitro, and the effects of topical glaucoma medications on oxidative stress in HTM cells. We used commercially available ophthalmic solutions of brimonidine, omidenepag isopropyl, and ripasudil in the study. HTM cells were exposed to H2O2 for 1 h, with or without glaucoma medications. We assessed cell viability and senescence via WST-1 and senescence-associated-β-galactosidase (SA-β-Gal) activity assays. After exposure to H2O2 and glaucoma medications, we evaluated changes in markers of fibrosis and stress by using real-time quantitative polymerase chain reaction (qPCR) to measure the mRNA levels of collagen type I alpha 1 chain (COL1A1), fibronectin, alpha-smooth muscle actin (α-SMA), matrix metalloproteinase-2 (MMP-2), endoplasmic reticulum stress markers of C/EBP homologous protein (CHOP), 78-kDa glucose-regulated protein (GRP78), and splicing X-box binding protein-1 (sXBP-1). HTM cell viability decreased and SA-β-Gal activity increased significantly after exposure to H2O2. Treatment with three ophthalmic solutions attenuated these changes. Real-time qPCR revealed that H2O2 upregulated the mRNA levels of COL1A1, fibronectin, α-SMA, CHOP, GRP78, and sXBP-1, whereas it downregulated MMP-2 mRNA expression significantly. Brimonidine suppressed the upregulation of stress markers CHOP and GRP78. Additionally, omidenepag isopropyl and ripasudil decreased the upregulation of COL1A1 and sXBP-1. Furthermore, ripasudil significantly suppressed fibrotic markers fibronectin and α-SMA, compared with the other two medications. In vitro, H2O2 treatment of HTM cells induced characteristic changes of OAG, such as fibrosis changes and the upregulation of stress markers. These glaucomatous changes were attenuated by additional treatments with brimonidine, omidenepag isopropyl, and ripasudil ophthalmic solutions. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion To present the process from acute Posner-Schlossman syndrome (PSS) relapse to remission under 2% ganciclovir (GCV), corticosteroids and anti-glaucoma agents on 323 patients.A retrospective study enrolling 323 PSS patients. Demographics and ophthalmic examination results were generated. Patients were treated with GCV, corticosteroids and anti-glaucoma agents andfollowed up every 2–6 weeks.Patients were divided into the GCV monotherapy (N = 65, 20.12%), GCV and corticosteroids (G+C, N = 106) and GCV, corticosteroid and IOP-lowering drugs (G+C+L, N = 152) group. The G+C+L group had the highest intraocular pressure (IOP, 26.33 ± 10.26 mmHg, P < 0.001) and largest cup-to-disc ratio (0.58 ± 0.19, P < 0.05). After treatment, IOP of three groups dropped to similar level. Ninety-nine (30.65%) patients were corticosteroid-dependent whose daily corticosteroid consumption decreased after using GCV (from 2.23 ± 1.02 to 0.97 ± 0.98 drops/day).2% GCV solutions worked effectively on PSS relapse with corticosteroids and anti-glaucoma agents. In patients suspected of CMV infection, proper GCV could reduce the chance of corticosteroid dependence. [ABSTRACT FROM AUTHOR]

This article provides an overview of plasma eye drop production trend in National Blood Centre, Malaysia and analysis of its usage in various ophthalmological pathologies. The amount of usage remains inconsistent and not increasing over the years. Analysis of indications for plasma eye drop use revealed that its use is limited to a few pathologies as well. Given its regenerative potential, more research is warranted to analyse treatment outcome using plasma eye drop in various pathologies which will serve as reference for establishment of guideline for its clinical use. [ABSTRACT FROM AUTHOR]

We propose a novel surgical technique in cases of aggressive recurrent pterygium non-subsidiary of treatment with conjunctival autografts or antimetabolites. Two presented cases were treated with surgical excision and a sutured plasma rich in growth factors membrane (mPRGF) followed by rich in growth factors (PRGF) eye drops treatment. After surgery, dexamethasone, tobramycin and PRGF eye drops were prescribed for 6 weeks. After a 12-month and 3-year post-surgical follow-up respectively, treated eyes with mPRGF did not present relapse, and visual acuity improved in both cases. No ocular complications, pain, eye discomfort nor other symptoms were observed. The combined use of PRGF eye drops and mPRGF seems an effective and safe therapy for recurrent pterygium. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of recalcitrant pseudomonas keratitis with a rare presentation of hyphaema. Observation: A 45-year-old female was noted to have contact lens-related pseudomonas keratitis with hyphaema. The organism was refractory to multiple antibiotics and only responded to Tazocin eye drops. Conclusion and Importance: Hyphaema is a rare presentation in bacterial keratitis and could represent infection with an especially virulent organism. Use of Aspirin could precipitate hyphaema in infective keratitis. Alternative antibiotic choices such as Tazocin, colistin, meropenem, and imipenem can be considered when standard therapy is ineffective for multidrug-resistant Pseudomonas keratitis. [ABSTRACT FROM AUTHOR]

To examine opioid prescribing following cataract surgery among patients who did or did not receive Omidria (phenylephrine and ketorolac intraocular solution 1.0%/0.3%) referred to as "P/K". The retrospective study compared adults over 65 without recent opioid use in the MarketScan databases who had a cataract-related surgical procedure between 1 January 2015 and 31 July 2019. Opioid prescription fills in the initial 2 and 7 days following surgery were compared between patients who did or did not receive P/K during surgery. We identified 218,672 older adults with cataract-related surgical procedures, of whom 5145 received P/K during surgery. Within 2 days of surgery, 0.50% of P/K patients and 0.68% of non-P/K patients received at least one opioid prescription. Pill counts in the first prescription post-surgery were lower for patients who received P/K than those who did not receive P/K (20 vs 45 respectively, p =.015). Findings were similar when a 7 day window was used. The reduction in opioids prescribed to patients who received P/K occurred despite the P/K-treated patients having a significantly higher incidence of preoperative comorbidities or risk factors for surgical complexity than patients who did not receive P/K (46.6% vs 31.3%, p <.001). Patients without recent opioid use who received P/K during cataract surgery, despite greater incidence of preoperative comorbidities and higher risk for surgical complexity, were prescribed fewer opioid pills following surgery than patients who did not receive P/K. [ABSTRACT FROM AUTHOR]

Introduction: First responders and those who work with organophosphate (OP) compounds can experience ocular symptoms similar to those caused by exposure to low levels of nerve agents. This study was designed to examine the efficacy of a safe, clinically available, simulant that reproduces ocular symptoms associated with low-level OP exposure. Among these ocular symptoms are a constriction of the pupils (miosis), decreased visual acuity, and changes in accommodation.Materials and Methods: Volunteers aged 18-40 were assigned to groups receiving either a two-drop or three-drop dose of FDA approved 2% pilocarpine ophthalmic solution. Baseline visual performance measurements were taken before eye drop instillation and a timer was started following the first drop of pilocarpine. Once eye drops were administered, visual performance including distant and near vision, pupil size, and accommodation were measured every 5 minutes for 2 hours.Results: Both groups experienced significant miosis in excess of 90 minutes. Visual acuity was significantly reduced because of accommodative changes. The three-drop group experienced longer lasting combined effects when compared to the two-drop group.Conclusions: 2% pilocarpine ophthalmic solution can safely simulate major ocular symptoms of OP exposure for behavioral research studies for at least 60 minutes. [ABSTRACT FROM AUTHOR]

Objective: We compared the benefits and harms of topical interventions for ocular perfusion pressure in open angle glaucoma. Methods: We searched the databases MEDLINE, EMBASE and CENTRAL for randomized controlled trials comparing topical hypotensive agents in glaucoma. Of the 9433 citations identified, 10 randomized controlled trials were included. We summarized data using random effects meta-analysis for post-treatment mean ocular perfusion pressure and using relative risk for adverse events. Results: Ten trials (416 patients) were included. The quality of included trials was low to moderate. There was a higher post-treatment ocular perfusion pressure with bimatoprost compared to timolol (1 trial, 32 patients, mean difference - 4.00 mmHg, 95% confidence interval -7.01 to -0.99, p = .009); heterogeneity was not significant (I2 = 41%, χ2 = 13.55, p = .09). Prostaglandins as a class had higher post-treatment mean ocular perfusion pressure compared to alternative interventions (5 trials, 147 patients, mean difference 2.19 mmHg, 95% confidence interval 0.67-3.70, p = .005); heterogeneity in the subgroup analysis was not significant (I2 = 10%, χ2 = 4.47, p = .35). Adverse events were found to be significant in only one of the studies comparing latanoprost to brimonidine, relative risk 3.67 (standard error 0.59, p = .03). Conclusions: We identified low to moderate quality evidence describing post-intervention mean ocular perfusion pressure in open angle glaucoma. Bimatoprost increases mean ocular perfusion pressure when compared to timolol. As a class, prostaglandins increase mean ocular perfusion pressure. Prostaglandins may provide beneficial ocular perfusion pressure profiles compared to alternative agents. [ABSTRACT FROM AUTHOR]

In hypertensive retinopathy, the retinal damage due to high blood pressure is accompanied by increased expression of Glial Fibrillary Acidic Protein (GFAP), which indicates a role of neuroinflammatory processes in such a retinopathy. Proteins belonging to the Rho GTPase family, particularly Rac1, are involved in the activation of Müller glia and in the progression of photoreceptor degeneration, and may thus represent a novel candidate for therapeutic intervention following central nervous system inflammation. In this paper, we have observed that topical administration as eye drops of Cytotoxic Necrotizing Factor 1 (CNF1), a Rho GTPase modulator, surprisingly improves electrophysiological and behavioral visual performances in aged spontaneously hypertensive rats. Furthermore, such functional improvement is accompanied by a reduction of Rac1 activity and retinal GFAP expression. Our results suggest that Rac1 inhibition through CNF1 topical administration may represent a new strategy to target retinal gliosis. • Rac1 may represent a novel candidate for therapeutic intervention following retinopathy. • CNF1 improves electrophysiological and behavioral visual performances in aged spontaneously hypertensive rats. • CNF1 topical administration, through Rac1 inhibition, may constitute a new therapeutic approach to target retinal gliosis. [ABSTRACT FROM AUTHOR]

Objectives: To assess the adherence to and identify the challenges in administering eye medications among patients with glaucoma in Malaysia. Methods: This was a 1‐year cross‐sectional study conducted at the Outpatient Pharmacy Department of the Raja Permaisuri Bainun Hospital, a public tertiary care centre. Patients with glaucoma, who self‐administered eye drops, were selected using the convenience sampling method and interviewed using the Brief Medication Questionnaire. The adherence of each patient was determined based on the total adherence score (0–1: good; 2–5 poor), while their responses to nine items describing the possible challenges in administering eye drops were dichotomized into 'yes' and 'no'. Key findings: One hundred patients with a mean age of 67.6 ± 10.4 years were interviewed. The majority of them were Chinese (69%) and male (56%). Approximately half of them received two types of eye medications for glaucoma. The overall adherence rate was found to be 75%, and the median adherence score was 1.00 (interquartile ranges: 1.00). However, no significant associations were found between the patient adherence and their sociodemographic characteristics. The most frequently reported challenges included 'eye drops falling on the cheeks' (45%), 'too many drops coming out of the eye drop bottles each time' (42%) and 'having difficulty in getting the eye medications refilled at the pharmacy on time' (25%). It is also found that experiences with side effects of medications were inversely associated with adherence (odds ratio (OR): 0.12; 95% confidence interval (CI): 0.02–0.76; P = 0.024), while inconvenient administration times led to a higher risk of nonadherence (OR: 14.17; 95% CI: 3.49–57.63; P < 0.001). Conclusions: Nonadherence to eye medications was shown to be a major challenge in glaucoma treatment in Malaysia. Interventions to strengthen the patients' commitment to the long‐term treatment, as well as their knowledge of the medications, are therefore warranted. [ABSTRACT FROM AUTHOR]

Background: Acuvue Oasys silicone hydrogel contact lenses (Senofilcon A) are used as bandage lenses and often combined with ophthalmic solutions in the treatment of ocular diseases. Concerns have been raised regarding the compatibility and effect of eye-drop solutions on the bandage lenses, which have led to frequent replacement of lenses causing clinical problems. Some patients experience pain or discomfort during treatments and the accumulation of drugs and preservatives in lenses has been suggested as a possible reason. The aim with this study was to investigate the effect of ophthalmic solutions on silicone hydrogel bandage lens material Senofilcon A in vitro and in vivo.Methods: The effect of three common ophthalmic solutions Isopto-Maxidex, Timosan and Oftaquix on Acuvue Oasys (Senofilcon A) bandage lenses was evaluated. An in vitro model method was developed where drug and preservative uptake by Acuvue Oasys was monitored with ultraviolet-visible spectroscopy and laser desorption ionisation mass spectrometry. Surface morphology changes of the lenses were evaluated using scanning electron microscopy. The method was then implemented for the in vivo pilot study evaluating lenses worn by patients.Results: In vitro model study monitoring the drug and preservatives uptake showed that the active ingredients from all the eye drops together with preservatives were taken up by the lenses in significant amounts. For the in vivo study no traces of active ingredients or preservatives could be found on the worn and treated lenses regardless of time being worn or dosage profiles. The surface morphology changes in the in vivo study were also minor in contrast to the changes observed in the in vitro scanning electron microscopy images.Conclusion: The in vivo results demonstrate minor effects of the ophthalmic solutions on the worn lenses. These results do not support the building up of preservatives and drugs on the contact lenses as the cause of pain or discomfort experienced by some patients, which is encouraging for the use of bandage lenses in combination with ophthalmic solutions. [ABSTRACT FROM AUTHOR]

There are over 400 000 cataract operations now being performed annually in the UK. With the majority of those patients being older people, comorbidities such as dementia or arthritis can prevent patients putting in their own postoperative eye drops. Where there is a lack of family or other support, district nursing services are often called upon to administer these eye drops, which are typically prescribed four times a day for 4 weeks, thus potentially totalling 112 visits for drop instillation per patient. To reduce the burden of these post-operative eye drops on district nursing services, administration of an intra-operative sub-Tenon's depot steroid injection is possible for cataract patients who then do not require any postoperative drop instillation. As a trial of this practice, 16 such patients were injected in one year, thus providing a reduction of 1792 in the number of visits requested. Taking an estimated cost of each district nurse visit of £38, this shift in practice potentially saved more than £68 000; the additional cost of the injection over the cost of eye drops was just £8.80 for the year. This practice presents an opportunity to protect valuable community nursing resources, but advocacy for change in practice would be needed with secondary care, or via commissioners. [ABSTRACT FROM AUTHOR]

Background Off-label use of topical ophthalmologic formulations for treatment of rhinologic disease is cited in recent literature and is anecdotally prevalent among practicing otolaryngologists. Steroids, antibiotics, and other drugs designed for ocular use have subjective clinical efficacy in the nose and sinuses, but their specific effects on the ciliated epithelium are less well defined. This study examines 9 commercially available ophthalmologic drug formulations for effects on ciliary motility in sinonasal cultures, in an effort to characterize their utility as topical therapies for sinonasal diseases. Methods Ophthalmologic solutions were tested on human sinonasal cultures grown at an air-liquid interface. Baseline ciliary beat frequency (CBF) was recorded and compared with CBF changes in the 20 minutes after drug addition. Substances were categorized by degree of ciliostimulation or cilioinhibition. Results All ophthalmologic solutions tested had only moderate effects on CBF during the 20-minute experimental period, with no solutions causing overt ciliostasis. Azithromycin, neomycin, and olopatadine were slightly ciliostimulatory, whereas levofloxacin, tobramycin, dexamethasone, azelastine, and prednisolone acetate were cilioinhibitory. Ciprofloxacin elicited moderate cilioinhibition that progressed to ciliostimulation. Conclusion All solutions tested appear to have moderate effects on ciliated cell surfaces for a period of time typical of mucociliary clearance (10 to 20 minutes). Both active drugs and excipients can play a role in ciliary modulation, and specific formulations can show unique or unexpected properties. Any other individual ophthalmologic solutions to be used in a nasal drug delivery system should be tested in this manner to evaluate potential ciliary effects before clinical use. [ABSTRACT FROM AUTHOR]

Purpose. The stability of 0.3-mg/mL tacrolimus ophthalmic solution at different storage temperatures was studied. Methods. A sterile ophthalmic solution of 0.3 mg/mL tacrolimus was prepared in triplicate under aseptic conditions by diluting tacrolimus in eye drops. Three aliquots of this solution were transferred into polypropylene bottles and stored at 25, 2-8, or -15 to -25 °C. Samples were collected immediately after preparation and at selected time points and assayed in triplicate using high-performance liquid chromatography (HPLC). Samples were also visually examined for macroscopic changes. The 0.3-mg/mL tacrolimus solution was also exposed to acidic treatment and heat to force its degradation and to evaluate the selectivity of the analytic method. The tacrolimus ophthalmic solution was considered stable if at least 90% of the mean initial concentration remained when analyzed by HPLC. Results. When stored at 2-8 °C and between -15 and -25 °C, at least 90% of the initial tacrolimus concentration remained throughout the 85-day study period. There were no significant differences in tacrolimus concentrations between the starting and ending points (p > 0.05). However, when tacrolimus solution was stored at 25 °C, the percentage of the initial tacrolimus concentration remaining had decreased to less than 90% on day 28. Conclusion. Tacrolimus diluted to 0.3 mg/mL in eye drop solution was stable for 20 days when stored at 25 °C and for at least 85 days when stored at 2-8 °C or between -15 and -25 °C in polypropylene bottles and protected from light. [ABSTRACT FROM AUTHOR]

One aspect to eye drop adherence is successful instillation of the drops; however, it is well known that many patients struggle with this task. Difficulties may include aiming their drops, extending their neck, preventing excess drop leakage, avoiding contamination of the bottle tip, and generating enough force to expel a drop from the bottle. Instillation aids are devices that aim to ameliorate one or more of these barriers. We review the literature on instillation aids to describe the options available to patients and to report evaluations of their efficacy. Most instillation aids studied improved objective or subjective outcomes of eye drop instillation, including improved rates of successful administration and increased patient satisfaction compared with standard eye-drop bottles. Although further research is warranted, instillation aids may be an underutilized resource for the many patients who struggle to administer their own eye drops. [ABSTRACT FROM AUTHOR]

Objective: To reduce the inappropriate identification of eye drops, through the use of different colors. Methods: A group of 34 healthy volunteers was presented to two groups of four eye drops each. All eye drops were placed in identical, unlabelled vials. In one group, all four eye drops were transparent. In the other group, each had a different color. A number was assigned to each eye drop, and the volunteer was asked to identify it by color. We measured the correct index in the identification of the eye drops of the two groups. Results: The volunteers had a level of education from incomplete junior school to complete graduate course, with 16 males (48%) and 18 females (52%), age range of 21 to 87 years. The success rate in the group of colored eye drops was 88% and, in the group of transparent, 24%. Conclusion: The use of colorings in eye drops can help distinguishing the vials and preventing misidentification. [ABSTRACT FROM AUTHOR]

Capillary electrophoretic (CE) and high performance liquid chromatographic (HPLC) methods were developed and optimized for the determination of antazoline (ANT) and tetrahydrozoline (TET) in ophthalmic formulations. Optimum electrophoretic conditions were achieved using a background electrolyte of 20 mM phosphate buffer at pH 7.0, a capillary temperature of 25 °C, a separation voltage of 22 kV and a pressure injection of the sample at 50 mbar for 17 s. HPLC analysis was performed with Kinetex (150 × 4.6 mm ID × 5 μm) (Phenomenex, USA) analytical column with 1 mL min −1 flow rate of mobile phase which consisted of 0.05% TFA in bidistilled water (pH adjusted to 3.0 with 5 M NaOH) and acetonitrile/buffer in the ratio of 63:37 (v/v) at room temperature. Injection volume of the samples was 10 μL and the wavelength of the detector was set at 215 nm for monitoring both analytes. Calibration graphs showed a good linearity with a coefficient of determination (R 2 ) of at least 0.998 for both methods. Intraday and interday precision (expressed as RSD%) were lower than 2.8% for CE and 0.92% for HPLC. The developed methods were demonstrated to be simple and rapid for the determination of ANT and TET in ophthalmic solutions providing recoveries in the range between 97.9 and 102.70% for CE and HPLC. [ABSTRACT FROM AUTHOR]

In this study, a simple and accurate high-performance liquid chromatography method was developed and validated for fast separation of three anti-glaucoma drugs: timolol maleate (TM), brimonidine tartrate (BM), and latanoprost (LP). Separation of the three drugs was achieved in < 6 minutes using a BDS Hypersil phenyl column and a mobile phase consisting of acetonitrile: 25mM phosphate buffer, pH 4.0 (50: 50, v/v) at 1.2 mL/min with UV detection at 210 nm. The method was linear over the concentration ranges of 5.0-200.0 µg/mL, 2.0-80.0 mg/mL and 1.0-25.0 µg/mL with lower detection limits of 0.21 µg/mL, 0.10 µg/mL and 0.11 µg/mL for TM, BM and LP, respectively. The method was applied for the determination of two fixed-dose combination eye drops for the treatment of glaucoma, containing TM together with either BM or LP. Commercial samples of single-ingredient ophthalmic solutions containing the studied drugs were also successfully analyzed. The results obtained by the proposed method were favorably compared with those obtained by the comparison methods using Student's t test and the variance ratio F test. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and compare the efficacy and safety of two investigational artificial tear formulations (CHO-1 and CHO-2) containing carmellose sodium, hyaluronic acid at different concentrations, and osmoprotectants, with a standard carmellose sodium-containing formulation (Refresh Tears [RT]) in the treatment of dry eye disease. Subjects and methods: In this 3-month, double-masked, multicenter study, subjects (n=305) were randomized 1:1:1 to receive CHO-1, CHO-2, or RT, used as needed but at least twice daily. The primary endpoint was change in ocular surface disease index (OSDI) score from baseline to day 90. Other key outcomes included symptoms evaluated on a visual analog scale, corneal and conjunctival staining, and adverse events. Results: OSDI scores and dry eye symptoms showed a rapid and sustained reduction from baseline in each group. Both CHO-1 and CHO-2 met the primary efficacy endpoint of noninferiority to RT in day 90 OSDI score change from baseline. OSDI ocular symptoms subscale improved more with CHO-1 than CHO-2 (P=0.048). In subjects with clinically relevant baseline ocular surface staining (>14 total score of a maximum of 55), day 90 improvements were greater with CHO-1 and CHO-2 than RT (P⩽0.044). Day 90 improvements in OSDI ocular symptoms subscale scores were also greater with CHO-1 than RT (P<0.007) in subjects with clinically relevant ocular staining. All treatments were well tolerated. Conclusion: Both combination artificial tear formulations were efficacious and well tolerated in subjects with dry eye. CHO-1 demonstrated the best performance in improving ocular symptoms and reducing ocular staining in this heterogeneous study population. [ABSTRACT FROM AUTHOR]

Chloramphenicol eye drops are commonly prescribed in concentrations of 0.5-1% in the treatment of infectious conjunctivitis. In terms of ophthalmic solution preparation, the major disadvantage of chloramphenicol consists in its low solubility in water. The solubility is increased by substances that form chloramphenicol-complexes, for example: boric acid/borax or cyclodextrins. Objective: Experimental studies aimed to evaluate the potential advantages of enhancing the solubility and stability of chloramphenicol (API) by molecular encapsulation in b-cyclodextrin (CD), in formulation of ophthalmic solutions buffered with boric acid/borax system. Methods and Results: We prepared four APIb- CD complexes, using two methods (kneading and co-precipitation) and two molar ratio of API/b-cyclodextrin (1:1 and 1:2). The formation of complexes was proved by differential scanning calorimetry (DSC) and the in vitro dissolution tests. Using these compounds, we prepared eight ophthalmic solutions, formulated in two variants of chloramphenicol concentrations (0.4% and 0.5%). Each solution was analyzed, by the official methods, at preparation and periodically during three months of storing in different temperature conditions (4°C, 20°C and 30°C). Conclusions: Inclusion of chloramphenicol in b-cyclodextrin only partially solves the difficulties due to the low solubility of chloramphenicol. The protection of chloramphenicol molecules is not completely ensured when the ophthalmic solutions are buffered with the boric acid/borax system. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the application of the eye drop administration technique by elderly. This is a transversal study conducted in the field of ophthalmology in the Medical Specialties Center of Aracaju. The study included 90 patients using eye drops, aged between 60 and 75 years old. First, the patient eye drop instillation technique was observed; after, an interview was performed with questions about the same aspects related to the administration of eye drops. The semi-structured questionnaire also included sociodemographic data and information on guidance received regarding the technique of administration. It was found that the majority of the elderly showed deviations from the proper technique of application of eyedrops in the observation and interview, respectively: they did not compressed the lacrimal region (97.8%, 96.7%), they did not keep their eyes closed for about two minutes (94.4%, 82.2%), they did not instilled the drops into the conjunctival sac (75.4%, 77.8%) and they allowed the eyedropper tip touch the eye (44.4%, 31.1%). We observed a statistically significant correlation between educational level and contact of the eyedropper tip with the eye (p = 0.010) during the observation. Among those who consulted with the doctor, only 28.2% had received information and those of whom were attended at the pharmacy, only 2.3% received counseling. Thus, it is important that health professionals instruct their patients, especially the elderly, about the correct eye drop instillation technique regardless how long it has been used and also according to the educational level of each patient. [ABSTRACT FROM AUTHOR]

Objective: Evaluate how difficult it is to apply ocular topical medications based on patient observation and answers to a questionnaire. Eye drops in open eyes were compared to vaporization in closed eyes. Methods: The study was a randomized clinical trial paired and held in the months of august and september of 2012 in the ophthalmological department of Polyclinic Ronaldo Gazolla (Arcos da Lapa Campus, Faculty of Medicine, University Estáciode Sá, RJ) in 50 patients. The Optive® ophthalmic solution was applied topically via an eyedrop bottle or a vaporizer through a randomized process. Patients were asked pre-formulated questions about the practicality of both methods and the technique of topical ocular drug delivery was observed. Results: 32% informed that it was difficult or very difficult to vaporize and 34% to use eye drops (p=0,9562). The major problem described by patients was to direct the eye drop to the eye surface. This difficulty was considered by 53% for vaporization and by 65% for topical eye drop use. 38% of the patients needed more than one eye drop application to have eye drop contact, while 30% of the patients needed more than one application of vaporization in order to get drug eye contact (p=0,5224). In 74% of patients there were an eyedropper tip contact with cilia, however there was one eye finger contact when the medicine was vaporized (p=0,5433). Conclusion: The ease perceived by patients to instil eye drops in open eyes was equivalent compared to the vaporization in closed eyes; the method of spraying was performed more appropriately due to the high frequency of eyedrop tip touches on the ocular surface. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to evaluate the efficacy of postoperative instruction on proficiency of eye drop instillation following cataract surgery, and to determine whether such proficiency correlates with the prevalence and/or duration of irritation and pain experienced in operated eyes. Design: This was a prospective, nonrandomized control trial with an educational intervention conducted via a single eye clinic in Accra, Ghana. Participants: The 218 subjects who completed the study were postoperative cataract surgery patients whose surgery had been funded by the nongovernmental organization Unite for Sight. Methods: Patients were evaluated on their ability to administer eye drops correctly on their first attempt on postoperative day one. If unsuccessful, patients were given an educational session that consisted of verbal instructions and an educational video. Both groups (successful and unsuccessful) on the first postoperative day were tested again for proficiency on postoperative day 30. The baseline group was evaluated only on postoperative day 30 and consisted of 36 patients. Results: Of the 133 patients who received the educational session on eye drop instillation, 112 (84%) exhibited proficiency on postoperative day 30 as compared with 29 of 49 patients (59%) who did not receive the intervention. Additionally, there were fewer reports of pain and irritation following cataract extraction in the patients who received the educational session. Conclusion: This study supports the efficacy of patient education in improving proficiency in eye drop instillation and in reducing pain and irritation following cataract extraction surgeries. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study reported here was to assess the efficacy of an artificial tear emulsion for the treatment of dry eye associated with meibomian gland dysfunction (MGD). Methods: At five clinics, patients completed a 1-week treatment with their habitual topical therapy and then a 4-week treatment with open-label study medication: Systane® Balance Lubricant Eye Drops (Alcon, Alcon Inc, Fort Worth, TX, USA). Subjective assessments included a preference survey, the Impact of Dry Eye in Everyday Life questionnaire, and the Work Productivity and Activity Impairment questionnaire. Objective assessments by unmasked investigators included visual acuity, meibomian gland expression and dropout, tear film breakup time, corneal staining, and dosing frequency. Results: At baseline, the 49 patients had mean meibomian gland expression grades and gland dropout that indicated mild to moderate MGD. Patients administered their habitual therapy 2.5 ± 1.3 times per day. After 4 weeks of study medication, the Impact of Dry Eye in Everyday Life questionnaire results indicated statistically and clinically significant improvements. Fewer than half of the participants were employed, limiting the usefulness of the Work Productivity and Activity Impairment questionnaire. Visual acuity remained statistically similar, while corneal staining and tear film breakup time improved significantly (P , 0.05) but modestly. The outcomes were achieved with 1.9 ± 1.1 doses per day of study medication, a significantly lower frequency than the habitual frequency (P , 0.001). The most common medication-related adverse event was blurred vision (3/49 patients, 6.1%). At study conclusion, 27/44 (61.4%) survey respondents preferred the study medication to their habitual therapy. Conclusion: The artificial tear emulsion was effective for treating the signs and symptoms of dry eye in MGD patients. [ABSTRACT FROM AUTHOR]

Topical timolol eyedrops are frequently used as medical treatment of glaucoma. They decrease the production of aqueous humor by blocking the beta adrenergic receptors of ciliary body. Although systemic absorption of eyedrops is negligible, still it can cause some serious side effects like bradycardia, heart block, bronchospasm, confusion and hypotension. We present a case who developed nightmares with use of topical beta-blockers. He was a chronic case of primary open angle glaucoma whose target intraocular pressure (IOP) couldn't be achieved with latanoprost alone, the first line drug, so we put him on topical timolol twice daily dosage to further decrease the IOP. On his follow-up visit he complained about bad dreams since starting timolol eye drops. This case report will add to the list of already known other side effects of timolol usage in glaucoma patients. [ABSTRACT FROM AUTHOR]

Introduction. The treatment of dry eye by autologous serum is a simple and inexpensive treatment option. It is particularly effective in severe forms of dry eye as well as for chemical eye injuries, and it is justified by the presence of essential tear components which are not found in preparations of artificial tears. The aim of this study was to analyze the effects of autologous serum therapy in the patients with dry eye. Material and Methods. We monitored the effect of one-month treatment of dry eye by autologous serum (used with artificial tear preparations) in 50 rheumatology patients (23 men and 27 women) aged 26-65 years at the Department of Ophthalmology, Clinical Center Nis. We analyzed ocular discomfort and the values of objective parameters for the evaluation of tear film at baseline and one month later (Schirmer I, Tears Break Up Time and Rose Bengal). Results. A statistically significant reduction of subjective complaints was found in the patients after the treatment by autologous serum (p<0.05), along with a minimal improvement of objective tests for checking the tear film quality. Discussion and Conclusion. The use of autologous serum in dry eye therapy should provide benefit to the patients, relieve symptoms and improve objective parameters for the evaluation of dry eye. Both doctors and patients should be adequately informed, and proper screening of potential users of this method should be done. Not only additional tests of therapeutic effect of autologous serum (as well as of umbilical cord serum or autologous plasma) are needed but also parallel clinical and histopathological examination and analysis of the effects of this type of treatment of dry eye. [ABSTRACT FROM AUTHOR]

Abstract: Objective:: The objective of this study was to assess the hypotensive efficacy of timolol maleate 0.5%, brinzolamide 1%, or brimonidine tartrate 0.2% ophthalmic solution, administered in conjunction with travoprost 0.004%, in patients with primary open-angle laucoma (OAG) or ocular hypertension (OHT) whose intraocular pressure (IOP) did not meet the treatment target using travoprost 0.004% monotherapy. Methods:: This was a randomized, comparative, investigator-masked study. Patients with OAG or OHT treated with travoprost 0.004% monotherapy were randomized to receive 1 of the 3 adjunctive therapies (timolol maleate 0.5%, brinzolamide 1%, or brimonidine tartrate 0.2%), 1 drop BID in each randomized eye, in addition to 1 drop QD of travoprost for a period of 4 weeks. IOP was measured on days 0 (travoprost 0.004%) and 28 (travoprost 0.004% and adjunctive treatment). Adverse events were monitored on days 0 and 28 by patient interview. Results:: Twenty-nine patients with OAG (46 eyes) and 3 patients with OHT (6 eyes), with a total of 52 eligible eyes, completed the study; 28 eyes were from male patients and 24 were from female patients. In addition to continuing travoprost treatment, 20 eyes received timolol, 16 eyes received brinzolamide, and 16 eyes were treated with brimonidine. There were no significant differences among the groups in the mean (SD) IOP at baseline on day 0 (19.0 [4.1], 17.2 [3.5], and 17.0 [3.1] mm Hg, respectively; P = NS). On day 28, the reduction in mean (SD) IOP in eyes treated with brimonidine tartrate 0.2% was significantly smaller (2.3 [1.8] mm Hg vs 3.9 [1.8] mm Hg [P = 0.01]) and the mean (SD) percentage reduction in IOP was significantly smaller (13.4% [9.1%] vs 20.2% [7.5%] [P = 0.01]) when compared with timolol maleate 0.5%, and likewise when compared with brinzolamide 1% (4.0 [2.1] mm Hg [P = 0.02] and 22.7% [8.6%] [P = 0.006], respectively). The group treated with brinzolamide was associated with a similar reduction in IOP to timolol (P = NS for both mean [SD] IOP and percentage reduction in IOP compared with timolol monotherapy). Barring the occasional conjunctival hyperemia, which was excluded as an adverse event for the purposes of this study, no adverse events were recorded. Conclusion:: Brinzolamide 1% and timolol maleate 0.5% treatment were both associated with a significantly greater reduction in IOP compared with brimonidine 0.2% when administered as a nonfixed adjuvant to travoprost 0.004% in the treatment of patients with OAG and OHT whose IOP was inadequately controlled with travoprost monotherapy. All treatments were well tolerated. [Copyright &y& Elsevier]

Abstract: We performed the quantitative analysis of chondroitin sulfate (CS) obtained from raw materials and various pharmaceutical preparations. To quantify CS content in raw materials and in an ophthalmic solution, each test sample and the authentic CS were first digested by chondroitinase ABC. The CS disaccharides produced were analyzed by strong anion-exchange high-performance liquid chromatography (SAX-HPLC) and CS content was quantified by calculating the total peak areas of the disaccharides derived from a CS calibration curve. In the case of soft capsules, CS was first extracted with hexane followed by phenol–chloroform to remove oil and protein ingredients. The extracted CS samples were depolymerized by chondroitinase ABC and CS content was determined. Quantitative analysis of the disaccharides derived from raw materials and an ophthalmic solution showed the CS contents (%) were 39.5±0.1 to 105.6±0.1 and 103.3±1.2, respectively. In case of CS analysis in soft capsules and liquid preparations, the overall recovery (%) of the spiked CS was 96.79±0.53–103.54±1.78 and 97.10±1.82 to 103.17±2.34, respectively. In conclusion, the quantitative analysis of the disaccharides produced by enzymatic digestion can be used in the direct quantitation of CS containing pharmaceutical formulations. [Copyright &y& Elsevier]

Ocular infections may arise from topical ophthalmic medications. A standard imposed by the British Pharmaceutical Codex implies that eye drops should be discarded after 1-day use when these remedies are used in outpatient departments. In this study the bioburden rates arising from 2, 4 and 7 days' use were evaluated and compared with those of 1 day's use to determine whether it is possible to extend the period of use of preserved eye drops in outpatient departments. A total of 200 eye drops were taken from outpatient departments of Farabi Eye Hospital after 1, 2, 4 and 7 days' use and the contamination rates of the residual contents, caps and droppers were determined using conventional techniques. High biobudren rates were obtained in all the samples tested. Although the overall recorded incidences of microbial contamination in the 2 and 4-day drops were not considerably different from those of first day (P>0.01) but those of 7 days' use were significant (P<0.01). However, when contamination rate of drop contents was taken into account there was a significant difference between 4 and 7 days' use compared to 1-day drops. Most of the isolated organisms were either of human flora types of Gram-positive bacteria or air-borne fungi. It is concluded that the use of eye drops for outpatient practice may be extended up to 2 days; yet, care should be taken to reduce the overall contamination rates of these preparations for prevention of ocular nosocomial infections. [ABSTRACT FROM AUTHOR]

A fully automated sequential injection spectrophotometric method for the determination of phenylephrine hydrochloride in pharmaceutical preparations is reported. The method is based on the condensation reaction of the analyte with 4-aminoantipyrine in the presence of potassium ferricyanide. The absorbance of the condensation product was monitored at 503 nm. A linear relationship between the relative peak height and concentration was obtained in the range 0.5–17.5 mg l-1. The detection limit (as 3σ value) was 0.09 mg l-1 and repeatability was 0.8 and 0.6% at 2.5 and 5 mg l-1, respectively. Results obtained by this method agreed very well with those obtained by the AOAC official method. [Copyright &y& Elsevier]

Purpose. To evaluate factors that may influence the ibopamine provocative test for the diagnosis of glaucoma. Methods. Two ibopamine (3,4 di-isobutyrylester of N-methyldopamine) 2% eyedrops were instilled 5 minutes apart in one eye selected at random in both glaucoma and normal subjects. The intraocular pressure (IOP) was assessed prior to the drops and 30, 60 and 180 minutes after instillation. The test was considered positive when there was an IOP increase of greater than 4 mmHg at any one of the timepoints. The amount of IOP change was compared to the severity of glaucomatous visual field loss and to the types of medical treatment. Results. The sensitivity (glaucoma patients with a positive result) and specificity (normal individuals with a negative result) of the ibopamine test was 87 and 95%, respectively. Glaucoma patients using prostaglandin analogues did not have a significant IOP elevation. Conclusion. The Ibopamine provocative test may be an auxiliary test in glaucoma diagnosis. Concurrent use of prostaglandin analogues reduces the test's sensitivity. [ABSTRACT FROM AUTHOR]

Ophthalmic solutions are available for multidose or single-dose administration in a wide variety of glass and plastic dropper bottles which deliver drops with a volume between 25 and 70 μl. From a biopharmaceutical and economic point of view, however, smaller volumes of 5 to 15 μl should be instilled. In this review, the technical, pharmaceutical, and therapeutic aspects of eye drop formation and delivery are presented. The different types of containers are described and the determinants of eye drop size are discussed, such as the design and physical characteristics of the dropper tip and bottle, the physico-chemical properties of the solution, and the manner in which the patient dispenses the drops. Preferred and alternative instillation techniques and aids to facilitate the administration of eye drops by elderly patients are described. [Copyright &y& Elsevier]

To estimate the daily cost of various ophthalmic solutions used in Japan for treating allergic conjunctivitis, including nine anti-allergic drugs and six anti-inflammatory drugs. The total number of drops of the anti-allergic drugs in a bottle ranged from 108 to 169 and that of the anti-inflammatory drugs from 100 to 145. The information in the package insert for these solutions recommends application 2–4 times daily. The price of the anti-allergic drugs studied ranged from $6.35 to $8.38 and that of the anti-inflammatory drugs studied from $2.02 to $5.20. The daily cost of the anti-allergic drugs studied varied considerably, from $0.26 to $0.57; for the anti-inflammatory drugs the range was from $0.12 to $0.20. Variations in the total launcher of drops per bottle and in the recommended dosage affect the daily cost of ophthalmic solutions. At current prices, the volume of a drop and the dosage had a greater effect on the daily cost than the price of a bottle. Daily cost data may be helpful in selecting ophthalmic products for treating allergic conjunctivitis in settings where the prices of a given drug are relatively uniform. [ABSTRACT FROM AUTHOR]

For the treatment of certain eye infections, ophthalmic solutions ‘laced’ with 25 mg/ml vancomycin are sometimes prepared. Their physical and chemical stability and the maintenance of their sterility were studied after deep freezing at −20±2 °C and thawing, followed or not by refrigeration for 48 h at 4±2 °C. Physical and chemical analysis comprised visual inspection turbidity, determination of pH and osmolality, and assay of vancomycin by high performance liquid chromatography with ultraviolet detection. For microbiological analysis a 25 mg/ml vancomycin ophthalmic solution was filtered through two membranes and cultured on trypticase-soy and Sabouraud-glucose solid media. Any colonies were then counted. These physical, chemical and microbiological analyses demonstrated the stability of 25 mg/ml vancomycin ophthalmic solutions in 5% glucose deep frozen at −20±2 °C for 3 months. The vancomycin concentration varied by no more than 5% of the initial concentration, and no breakdown product was evidenced. Neither pH (mean=3.8±0.1) nor osmolality (mean=318.3±5.6 mOsm/kg) varied significantly, and remained compatible with intraocular administration. No particle or bacterial combination was found in the course of the study. The thawing procedure (at ambient temperature or under warm running water from a tap) did not modify the stability of the eye drops. Likewise, storage in a refrigerator for 48 h after thawing did not modify stability. The advantage of storing vancomycin 25 mg/ml ophthalmic solutions for 3 months in deep freeze is that a stock of chemically and microbiologically controlled preparations can be held ready for administration to patients, thereby allowing prompter dispensing, as the eye drops are not made up extemporaneously, while the improved control over production ensures that patients receive solutions of constant quality, as every batch prepared is systematically inspected. [Copyright &y& Elsevier]

The frequency of thimerosal sensitization was determined in 5 groups of subjects: military recruits; healthy subjects; patients with asthma or rhinitis undergoing hyposensitizing therapy with thimerosal- preserved antigenic extracts; patients with allergic contact dermatitis; patients with allergic contact conjunctivitis. Our patients with allergic contact dermatitis have a higher incidence of positive patch tests to thimerosal than healthy subjects. The source of thimerosal sensitization in this group remains obscure, their history of exposure to this or to other mercury derivatives being comparable to that of the healthy population. Patients with allergic contact conjunctivitis and patients receiving immunotherapy for asthma or rhinitis present a significantly higher frequency of thimerosal sensitization than the other groups, indicating that ophthalmic solutions and thimerosal-preserved allergen extracts are an important source of thimerosal sensitization. The clinical relevance of thimerosal sensitization was definitively established only in patients with allergic contact conjunctivitis, even though patients receiving immunotherapy frequently presented local reactions at the site of allergen inoculation. [ABSTRACT FROM AUTHOR]

Abstract: Adverse systemic reactions such as cardiovascular effects may occur following topical ocular application of phenylephrine. We report the case of a 49-year-old woman who, following topical application of phenylephrine eyedrops, experienced hypertension with electrocardiographic modifications and a rise in cardiac troponin Ic. [Copyright &y& Elsevier]

Image, graphical abstract To assess the physico-chemical stability of Voriconazole Eye-Drops (VED), when stored frozen and refrigerated once thawed, in 3 containers: Amber glass with a Low-Density PolyEthylene (LDPE) eyedropper, and two types of LDPE bottles: one classical and one with an innovative insert that maintains sterility after opening (Novelia® from Nemera). Three batches of 1% VED (10 mL) were aseptically compounded from marketed injectable voriconazole (Vfend®) diluted in sterile water for injection. VEDs were stored for three months at -20°C in amber glass (n = 32), classical LDPE (n = 32) or innovative LDPE (n = 31) bottles. Stability-indicating (HPLC-UV-DAD) and chiral chromatography methods were developed. The stability study was conducted according to GERPAC-SFPC guidelines. At each study time, the following parameters were controlled: visual aspect, voriconazole concentration, pH and osmolality. In addition, non-visible particle count, sterility and absence of racemisation (impurity D – (2S,3R)-voriconazole) were assessed at the beginning and end of the study. Results are expressed as mean ± standard deviation. Statistical analyses were performed using non-parametric tests (α < 5%) to compare containers. When stored frozen, concentration was between 95.2 ± 1.4% and 103.6 ± 1.3% of the initial concentration (C0) with no difference between the three containers (p = 0.564; non-significant). Fifteen days after thawing, concentration was between 97.1 ± 1.6% and 98.6 ± 0.8% of C0 with no difference between containers (p = 0.278 and 0.368 for VED thawed at room temperature and at 2–8°C, respectively). pH remained stable between each time. Osmolality was slightly higher in glass (533.17 ± 8.93 mOsm/Kg) than in plastic containers (522.17±3.31mOsm/Kg, classical LDPE; 517.5 ± 12.42 mOsm/Kg, innovative LDPE) (p = 0.022). Sterility was preserved. Degradation product areas increased slightly but remained below the limit of quantification. Impurity D was never detected. We have demonstrated that the ability of the innovative container Novelia® to maintain VED physicochemical and microbiological stability does not differ from that of amber glass and classical LDPE containers. Real life studies are required to find out if there is a potential difference between Novelia® and other containers in terms of sterility preservation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 70-year-old man with glaucoma wherein he was treated with eyedrops containing timolol maleate and brimonidine tartrate. The patient had developed erythematous and oedematous pruritic lesions on both cheeks for using the eyedrops. The patient was diagnosed with allergic contact dermatitis caused by timolol maleate with a repeated open application with brimonidine tartrate. It examines the reactions of the eyedrops to the skin of the patients.

The article focuses on the research "In open-angle glaucoma, latanoprost improved visual field preservation." Topics discussed include glaucomatous defects in the visual field and corresponding optic nerve head damage, latanoprost increased time to first deterioration compared with placebo, and increased risk for systemic side effects of glaucoma medications if prescribed to patients despite underlying medical conditions.